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LETTER TO EDITOR
Year : 2011  |  Volume : 48  |  Issue : 1  |  Page : 120-121
 

An unusual variant of leiomyoma masquerading peroperatively as sarcoma


Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India

Date of Web Publication10-Feb-2011

Correspondence Address:
V K Arora
Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.76636

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How to cite this article:
Aggarwal S, Arora V K. An unusual variant of leiomyoma masquerading peroperatively as sarcoma. Indian J Cancer 2011;48:120-1

How to cite this URL:
Aggarwal S, Arora V K. An unusual variant of leiomyoma masquerading peroperatively as sarcoma. Indian J Cancer [serial online] 2011 [cited 2019 Aug 19];48:120-1. Available from: http://www.indianjcancer.com/text.asp?2011/48/1/120/76636


Sir,

A 52-year-old woman para 3, with 3 live births presented with menorrhagia and uterine prolapse in the gynecology outpatient department. She had 3 o uterovaginal prolapse with cystocele and enterocele. On ultrasonography, a large fibroid of uterus was seen. Total abdominal hysterectomy with left salpingo-opherectomy was done.

Per-operatively, a large, exophytic, multinodular 10×10 cm, red-brown tumor having multiple bulbous processes was seen. The tumor extended into the peritoneal cavity and left broad ligament and was attached with a pedicle to the uterus in the region of the left cornua [Figure 1]a. The exophytic mass was continuous with an intramural component dissecting the surrounding myometrium.
Figure 1a: Gross: Total abdominal hysterectomy specimen with left salpingo-oophorectomy. There is a 10 10 cm, exophytic, multinodular red-brown tumor comprising multiple bulbous processes (arrows) that extended into the peritoneal cavity and left broad ligament from a pedunculated attachment to the uterus in the region of the left cornu.
b: (Hematoxylin and Eosin × 200): Areas of benign smooth muscle fibers arranged in interlacing fascicles or swirls with focal hydropic degeneration.


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Because of this alarming appearance of the tumor, the possibility of sarcoma was considered during surgery. On microscopic examination, bulbous processes were found to be composed of disorganized fascicles of benign smooth muscle fibers arranged in interlacing fascicles or swirls. There was focal hydropic degeneration [Figure 1]b.

Significant nuclear atypia, mitotic activity, and coagulative tumor necrosis were conspicuous by their absence. No intravascular involvement was present. The patient was apparently healthy 6 months post surgery.

Morphological diagnosis of cotyledonoid leiomyoma was made. Leiomyoma are benign smooth muscle proliferations of the uterus, frequently found in women in the age range of 30-45 years. These are the most common types of abnormal pelvic growth in women, affecting mostly the body of the uterus, but may also be found in the cervix, broad ligament, and, rarely, the ovary. Estrogens and estrogen receptors play a major role in the pathogenesis of leiomyoma. In the uterus, these tumors may be intramural, submucosal and subserosal. Grossly, the cut surface is firm and rubbery, and shows a whorled, spiral pattern of fibers. Cotyledonoid dissecting leiomyoma is a rare variant. To date, only 11 cases have been reported in the English literature. [1],[2],[3],[4],[5],[6],[7]

Cotyledonoid leiomyoma or "grapelike leiomyoma" or "Sternberg tumor" is a rare variant of benign uterine leiomyoma characterized by extrauterine bulbous growth having continuity with a dissecting myometrial component. The tumor grossly resembles placenta. The median age of patients at presentation is 40 years (range, 23-65 years). Because of lack of familiarity with the alarming fungating appearance of cotyledonoid leiomyoma, the large size of the tumor and the apparent widespread infiltrative growth with frequent extension into the pelvic cavity and broad ligament, and even into the retroperitoneal space, grossly mimics malignancy.

Increased awareness of this grossly alarming variant of uterine leiomyoma can help avoid over-treatment at the time of surgery.

 
  References Top

1.Roth LM, Reed RJ, Sternberg WH. Cotyledonoid dissecting leiomyoma of the uterus: The Sternberg tumour. Am J Surg Pathol 1996;20:1455-61.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Menolascino-Bratta F, Garcia de Barriola V, Naranjo de Gomez M, Garcia Tamayo J, Suarez JA, Hernandez Chacon AV. Cotyledonoid dissecting leiomyoma (Sternberg tumour): An unusual form of leiomyoma. Pathol Res Pract 1999;195:435-8.   Back to cited text no. 2
    
3.Cheuk W, Chan JK, Liu JY. Cotyledonoid leiomyoma: A benign uterine tumour with alarming gross appearance. Arch Pathol Lab Med 2002;126:210-3.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Kim MJ, Park YK, Cho JH. Cotyledonoid dissecting leiomyoma of the uterus: A case report and review of the literature. J Korean Med Sci 2002;17:840-4.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Stewart KA, Ireland-Jenkin K, Quinn M, Armes JE. Cotyledonoid dissecting leiomyoma. Pathology 2003;35:177-9.   Back to cited text no. 5
[PUBMED]    
6.Gurbuz A, Karateke A, Kabaca C, Arik H, Bilgic R. A case of cotyledonoid leiomyoma and review of the literature. Int J Gynecol Cancer 2005;15:1218-21.   Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Cheuk W, John K, Chan C, John Y, Liu S. Cotyledonoid Leiomyoma A Benign Uterine Tumor with Alarming Gross Appearance. Arch Pathol Lab Med 2001;126:210-3.  Back to cited text no. 7
    


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This article has been cited by
1 Cotyledonoid dissecting leiomyoma of the uterus: A review of clinical, pathological, and radiological features
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